Odontogenic tumors
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Transcript of Odontogenic tumors
Haditha city
CLASSIFICATIONI . Tumours of odontogenic epithelium 1. Ameloblastoma •Malignant ameloblastoma •Ameloblastic carcinoma2. Calcifying epithelial odontogenic tumor 3. Squamous odontogenic tumor 4. Clear cell odontogenic carcinoma 5. Primary intraosseous carcinoma
II . mixed odontogenic tumours 1. Ameloblastic fibroma 2. Ameloblastic fibro-odontoma 3. Ameloblastic fibrosarcoma 4. Odontoameloblastoma 5. Odontoma •Compound composite •Complex composite6 Adenomatoid odontogenic tumor
III . Tumours of odontogenic ectomesenchyme1. Odontogenic fibroma 2. Granular cell odontogenic tumor 3. Odontogenic myxoma4. Cementoblastoma
AMELOBLASTOMA common epithelial odontogenic
tumor Benign, but locally invasive Asymptomatic and remain
undiscoverd until growth produce expantion ,tooth and dental occlusion disturbances, or incidental radiograph reveal the lesion
In some rare cases paresthesia and pain may occur and associated with root resorption and tooth displacement
Most commonly forms in posterior mandible
age at which lesion became clinically evident is third to fifth decade
Inadequate treatment usually followed by aggressive recurrence
CLINICAL PRESENTATION OF AMELOBLASTOMA
SUBTYPES OF AMELOBLASTOMA
Multicystic (multilocular) and solid (86%)
Unicystic (unilocular) (13%)
peripheral (extraosseous) (1%)
MULTICYSTIC AMELOBLASTOMA
Clinically is the most common form of this lesion,
nearly occur in patients over 25 years of age. With no sex predilection
The lesion may cause extensive deformities of the mand. & max.
It is most commonly located in the mand , with 75% occurring in the molar & ascending ramus area.
The tumor is slowly growing, locally aggressive, allows time for periosteum to produce a thin shell of bone which cracks easily when palpated
known as ( eggshell cracking).
RADIOGARAPHICALLY
Classic–multilocular radiolucency of posterior mandible.
Well-circumscribed, soap-bubble appearance
Unilocular – often confused with odontogenic cysts
Root resorption –usually associated
with Malignancy
HISTOPATHOLOGY
Two main patterns – plexiform and follicular , and other rare types
acanthomatous, granular cell,desmoplastic,basal cell
Classic – sheets and islands of tumor cells,
outer rim of ameloblasts is polarized away from basement membrane
Center looks like stellate reticulum
Squamous differentiation (1%) – Diagnosed as ameloblastic carcinoma
UNICYSTIC AMELOBLASTOMA
Mostly found within the lining of a large unilocular cyst specially the Dentigerous cyst.
commonly associated with the crown of an impacted tooth in a young patient.
Average age 23 years
90% in mandible (usually posterior regions)
Asymptomatic but may cause painless swelling
RADIOGRAPHICALLY
Typically appears as circumscribed Unilocular radiolucency that surrounds the crown of unerupted mandibular third molar.
or multilocular (25%) radiolucency .
HISTOPATHOLOGY: The lesion composed
of island of epith. which may be follicular or plexiform within the epith. lining of the cystic wall.
Some lesions will contain areas in which the epith. Is thickened with papillary projections extending into the lumen, this called “intraluminal unicystic ameloblastoma”
When the thickened lining penetrates the adjacent capsular tissue, it’s termed “mural unicystic ameloblastoma.
PERIPHERAL AMELOBLASTOMA (EXTRAOSSEOUS)
very uncommon
histologically similar to the intraosseous common ameloblastoma but is limited to the soft tissues of the gingiva.
TREATMENT
Treatment range from simple enucleation and curretage to block resection.
recurrency reported in 55% to 100% for multicystic lesion and about 18 to 35% for unicystic lesion after curretage or enucleation
curettage can disperse the tumor into uninvolved areas
The best chance for completely removing the lesion is by marginal block resection with 1,5 to 2 cm safe margin for multicystic lesion
and 1 to 1,5 cm for unicystic and peripheral lesions.
Because children and adolescents with ameloblastoma are still developing physically and psychologically, Conservative treatment can get good results . nonresectable ameloblastoma can be treated by Radiotherapy.
Long term followup up to 20 years and even more required.
MALIGNANT AMELOBLASTOMA
It is benign ameloblastoma of jaws but show metastatic growth.
metastasis may occure to the hip ,vertebrae,brain,kidney and even myocardium but The most common sites for metastasis are the lungs
Lung metastases regarded as aspiration phenomena, while the peripheral location of many of these deposits supports hematogenous spread.
metastasis usually associated with multicystic ameloblastomas rather than unicystic tumors.
Hypercalcemia may be a marker of metastatic disease in some instances
due to production of parathyroid –related protein (PTHrP) by metastatic ameloblastic cells in lung and bone .
AMELOBLASTIC CARCINOMA
An ameloblastoma that has cytological features of malignancy
Although ameloblastic carcinomas have been reported to metastasize to the lungs and distant organs many cases do not metastasize.
rapid growth and pain were common symptoms.
The treatment is similar to that of an intraosseous carcinoma but the prognosis is poor if metastases are present.
CALCIFYING EPITHELIAL ODONTOGENIC TUMOUR (PINDBORG TUMOR)
uncommon epithelial lesion that accounts for < 1% of all odontogenic tumors.
most often in patients between 30 and
50 years of age with no gender predilection
Approximately two-thirds of these neoplasms occur in the mandible
A painless slow-growing mass is the most common presenting sign
Locally invasive but does not metastasis
RADIOGRAPHICALLY
most common presentation is a mixed radiopaque/radiolucent lesion, frequently associated with an impacted tooth
HISTOPATHOLOGY
the Pindborg tumor is quite unique.
islands, strands, or sheets of epithelial cells in a fibrous stroma .
Large areas of amorphous eosinophilic hyalinized (amyloid-like) material are also present.
Some cases show clear cells ,prominent clear cells associated with increased the aggressiveness of the lesion.
Calcifications, which are a distinctive feature of the tumor, develop within the amyloid-like material and form concentric rings, known as
Liesegang rings
TREATMENT
tumor is generally recommended to be treated identically to the ameloblastoma and odontogenic myxoma,
with 1.0 to 1,5 cm bony linear margins and the appropriate attention to soft tissue anatomic barriers .
Small lesions can be treated by enucleation followed by vigorous curettage .
The prognosis of CEOT is good with infrequent recurrence . the recurrence rate about 14 % and recurrent lesion may not be manifested for many years.
Tumors with more amyloid and calcified content tend to have better prognosis in compare to that of clear cell variant .
CLEAR CELL ODONTOGENIC CARCINOMA a rare epithelial odontogenic tumor
associated with aggressive clinical behavior with metastasis and low survival rate.
The classic clinical presentation of CCOC is a painful anterior mandibular swelling in an elderly women.
characterised by sheets and islands of vacuolated and clear cells which not stain in histological preparation because of rich glycogen giving an empty appearance .
TREATMENT
Tumor may be aggressive and are capable of local recurrence, as well as regional and distant metastasis
Such tumors should be treated by wide en-bloc resection with long-term follow-up
In the presence of clinical and/or radiographic evidence of nodal metastases, neck dissection should also be performed .
PRIMARY INTRAOSSEOUS SQUAMOUS CELL CARCINOMA
it is rare epithelial odontogenic tumor
assumed to arise from odontogenic epithelium or linings of odontogenic cysts.
It may be solid or cystogenic
typically occur in the posterior region of mandible of elderly male .
Pain and paresthesia may occur
Radiographically variable depending on the progression of the disease from outlined radiolucencies to diffusely infiltrative lesions
TREATMENT
The prognosis associated with PIOC of the jaws is poor and suggests the need for aggressive treatment
Treated by resection followed by postoperative radiotherapy .
ODONTOMA
are developmental malformations(hamartomas) of dental tissues.
Odontomas are the most frequently occurring odontogenic tumors, with prevalence exceeding that of all other odontogenic tumors combined.
Usually found between ages 10 and 20 years with no gender predilection
May be compound or complex
Impaction of permanent teeth was the most common complication associated with odontoma
COMPOUND ODONTOMA
many small teeth
Most common sites are anterior maxilla
COMPLEX ODONTOMA
disordered mass of dental hard tissue
Most common site are posterior mandible or maxilla
Treatment ;
Odontomas are treated with simple enucleation and curettage .
Not known to recur .
ODONTOGENIC MYXOMA
Rare ectomesenchymal Neoplasm
histologically resembles the dental papilla of the developing tooth.
Usually seen in young adults
Radiographically, the odontogenic myxoma appears as a unilocular or multilocular radiolucency that may displace or cause root resorption of teeth in the area of the tumor
In some patients the tumor may have a greater tendency to form collagen fibers; such lesions are designated as fibromyxomas
slow growing with a potential for aggressive behavior and a high recurrence rate after subtherapeutic removal.
TREATMENT
These tumors are not encapsulated and tend to infiltrate the surrounding bone such that complete removal by curettage is nearly impossible.
Odontogenic myxomas should be treated with resection with 1.0 cm bony linear margins as confirmed with a specimen radiograph or frozen section .
Treated by excision with a small margin Can undergo malignant changes
AMELOBLASTIC FIBROMA
Rare mixed odontogenic tumor
Usually seen in children or young adults
the posterior mandible is affected in 70% of cases
Solid lesion but appears as unilocular or multilocular radiolucency
Treated by excision with small margin
Huge lesions especially which appear Multilocular are best treated by
resectionwithout continuity
AMELOBLASTIC SARCOMA (AMELOBLASTIC FIBROSARCOMA)
it is rare mixed malignant odontogenic tumor .
It is invasive and destructive but has little tendency to metastasise.
Reports suggest that approximately 50% arise from ameloblastic fibromas.
Radiographically appear as ill-defined destructive radiolucent lesion
Local excision usually followed by rapid recurrence so it is best treated by radical surgical excision
ODONTO-AMELOBLASTOMA ; (AMELOBLASTIC ODONTOMA)
Extremly rare mixed odontogenic tumour
More in mandible of younger patients
pain ,delayed eruption of teeth , expantion of affecting bone may occur
Radiographically show radiolucency with calcified structures
Treated similar to ameloblastoma because local excision usually followed by multiple recurrence
ADENOMATOID ODONTOGENIC TUMORADENOAMELOBLASTOMA,GLANDULAR AMELOBLASTOMA,ADENOMATOID AMELOBLASTOMA
Some consider it as a hamartoma
uncommon , accounting for 3 to 7% of all odontogenic tumors.
limited to young ,extremely uncommon in patients > 30 years.
Maxilla > mandible Anterior region > posterior region Female > male rarely exceeding 3 cm in diameter
lesion appears as a well-circumscribed unilocular radiolucency that involves the crown of an erupted tooth, frequently a canine.radiolucency extend beyond the cemento-enamel junction
TREATMENT
Histologically, the adenomatoid odontogenic tumor is a well-defined lesion that is usually surrounded by a thick fibrous capsule
Owing to this lesion being encapsulated, it separates easily from the surrounding bone.As such, an enucleation and curettage surgery is curative
ODONTOGENIC FIBROMA rare ectomesenchymal odontogenic tumour
Clinically, It forms a slow-growing asymptomatic mass which may eventually expand the jaw.
radiographically , it appears as a sharply defined, radiolucent area in a tooth-bearing region.
Calcifications composed of cementum-like material or dentinoid are present in some cases
Odontogenic fibromas are benign and shell out from their surrounding tissues .
CEMENTOBLASTOMA
benign ectomesenchymal neoplasm of cementum and forms a mass of cementum-like tissue as an irregular or rounded mass attached to the root of a tooth, usually a mandibular first molar.
mainly affect young adults, particularly males.
They are slow-growing and the jaw is not usually expanded. And may rarely causes gross bony swelling and pain
Radiographically, there is typically a radiopaque mass with thin radiolucent margin, attached to the roots of a tooth.
Resorption of related roots is common, but the tooth remains vital.
Treatment ; by enucleation
References :Neville, Oral and Maxillofacial Pathology, 2nd Ed
cawsin Essentials of Oral Pathology and Oral Medicine ,7th Ed
Peterson's Principles of Oral and Maxillofacial Surgery 2nd Ed 2004
Oral and Maxillofacial Surgery, Raymond J. Fonseca
World Health Organization (WHO) Classification of Tumours , IARCPressLyon, 2005
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